| NPI | 1538512355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 69492) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57246056) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 69492) | |
| 208600000X Surgery (Licence: IL 125.068729) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.068729) | |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2024-04-12 |